Showing posts with label tests. Show all posts
Showing posts with label tests. Show all posts

12.08.2019

Preparing for the California Acupuncture Licensing Exam (CALE)


To my fellow students of Chinese medicine who love the medicine itself, but struggle with standardized testing, this is for you.


A note for non-practitioners about acupuncture licensing exams

In the USA, Chinese medicine is state- regulated. California has the most stringent educational and other licensing requirements. It is the only state that does NOT recognize the National acupuncture licensing exam (NCCAOM). The NCCAOM has four modules: foundations, acupuncture, Western medicine, and herbal medicine. Each module is taken separately, with 100 questions and 2.5-hours each. This makes it easier for students to prepare for the exam, studying one topic at a time.

The California Acupuncture Licensing Exam (CALE) combines the four NCCAOM modules into a grueling 5-hour 200-question exam with more trick questions, complex case studies, and clinically irrelevant trivia than the NCCAOM.


Test Preparation programs

Here are the three main test preparation programs, listed from least to most expensive:
- TCMreview.com (I used this program)
- TCMtests.com (I used only during free days)

Using a test preparation program streamlines the intimidating process of reviewing 4 years of accumulated material, 2000 years of history, changing rules/ regulations, and shifting western medicine research.

Choose either TCM-review or Linda Morse’s program for your base program. Search on Youtube for some free sample videos from both to taste their teaching style, and see what resonates. I enjoyed TCM-review’s well-organized content. Bina teaches all of the Chinese medicine classes, methodically covering what to focus on through HB Kim and the course reader. Whenever I had a question, I directly emailed or called her, which was deeply helpful. TCM-review posts free review questions onto Facebook daily.

TCM-tests has helpful test review questions. The first Tuesday of every month is free. So, go test-drive the site to check it out! They post daily review questions onto their site, as well.

I enrolled in TCM-review’s self-guided CALE preparation program during my final quarter of school. I struggled to finish the weekly modules, which included 3 hours of videos, a handful of quizzes, and readings. I went overboard and exhausted myself for the first few months, before I learned to keep it simple:


  • Only highlight, write down, or study what Bina emphasizes.
  • If something is particularly confusing, either look up more information in a different academic resource or email Bina. She usually responds within a day, with helpful and encouraging explanations/ suggestions.



Time management

My first panic attack hits at 4:30 AM, a month before my first exam, the NCCAOM foundations module. As I stand retching over the bathroom sink in the pre-dawn darkness, I realize I have to change. I was working too hard, and driving myself into an inefficient, anxious frenzy.

I re-prioritized my study strategies and life design:

Mornings


- I journal and sip tea first thing in the morning (usually around 5 AM), prior to studying, or any internet exposure. I light a candle and some incense, invoking support from my ancestors (excellent test takers), and the Earth.

- I then study until 6 or 7 AM, going through whatever is most important, usually taking a quiz, watching a video, or editing flashcards.

- After morning study, I practice yoga asana, eat breakfast, then resume studies by 9 AM.

I enjoy a weekly “study adventure” to local wild places, overflowing my fanny pack with food and study material. I walk, bike, and drive to a rotating collection of mountains, rivers, local parks, and the ocean.


Work


After graduating, I increased my yoga-teaching class load to 7 studios, scheduling classes in the evenings, when I am less productive, but ready for social engagement. Test preparation can be lonely, and mentally, emotionally, and spiritually draining. Teaching yoga provided an incredible balance: I share what I love, engage with people who I care about, and integrate information on all levels.

Are you more focused and productive in the mornings or evenings? Pattern your day according to your natural rhythms. I honor my "morning person" temperament by only scheduling appointments after lunch.

I cancelled all teaching engagements three weeks before my exam. Walking in the hills going through flashcards, I notice rising anxiety and overwhelm, and realize, “I do NOT want to teach tonight’s class.” I was so focused that any disturbances would cause more stress.

Notice how you are feeling. Make life changes as necessary to support your study success!

Evenings


I prefer studying outdoors during the day, and doing computer-oriented work in the evening, such as taking quizzes, editing flashcards, or watching videos. I try to climb into bed by 10 PM. Most nights, I feel a sense of guilty incompleteness: I didn’t study enough today. I felt a constant sense of not enough. This feeling is miserable and useless, but difficult to combat. I tried to push it back by covering flashcards until I fell asleep, but this would usually give me anxiety-dreams, or nightmares.

Set a time to stop studying. Give yourself a break. It’s difficult to stop, when you’re a perfectionist workaholic (as I am). But, it’s absolutely necessary, to prevent burnout, panic attacks, or worse. Resting peacefully each evening allows information integration, building long-lasting brain-trails.


Flashcards


Bina recommends making flashcards for everything covered in the course (besides what you know very well already) and having a daily strategy of studying all flashcards nightly, setting aside cards you’re getting wrong, then reviewing the “wrong” flashcards first thing the next morning.

I couldn't use Bina's technique. I made a total of 8350 flashcards through my six months of study, assiduously inputting each week’s information into Quizlet. I was overwhelmed by my massive collection, and inefficient in reviewing them. I quickly fall asleep if I sit around and study. I need constant movement and diverse natural environments.

The still sacred silence of the hills/ mountains helps me focus; I quickly move through large amounts of study material. I walk with flashcards until I find a beautiful place to study, am hungry, or am so mentally exhausted that I must rest. I then sit in the shade, flip through books or charts, or cover larger flashcards that are too complicated to read while walking.

Paper flashcards get bulky and fly away when it’s windy. I prefer online/ digital flashcards. Quizlet supported me through graduate school, and continued to help me pass my board exams. I enjoy adding photos onto complex cards, keeping cards organized in folders, seeing other students' cards, and Quizlet's ability to read me my cards. I walk, listening to my cards, starring and unstarring, gazing down every once in a while for clarification.

I organize material into specific folders, numbered according to priority. I “star” my "wrong" flashcards, studying the starred cards the next day. I keep track of everything by charting when I cover a flashcard set, how many are starred, and how many total in the set. As my test date drew closer, I noted "mastered" categories with a blue circle.

I created larger flashcard categories for sitting and reading/ studying. I created smaller flashcards for walking. I noted which flashcards were for walking (走), or sitting (坐).

Keep topics small, to move through quickly, and Quizlet-readable while walking. Color-code. Write things down over and over. Make studying fun, colorful, and physical.


It’s a Marathon


I prepared for the CALE for 6 months. During school, I studied as much as possible between school, work, and 450 miles of travel each week. After graduation, I studied every single day, all day on most days. I scheduled in at least one hour-long physical activity daily, besides teaching and practicing yoga. Your study strategy depends on you.

What type of learner are you? I’m a kinesthetic learner and artist. I enjoy the physicality of programming flashcards into the computer, making them fun and beautiful, and then walking with them through miles of wilderness. Bina suggested a rigorous study schedule: scheduling topics each morning, then studying in 2 hour blocks. I tried to follow the regimen off and on for a few months, and found it anxiety-provoking. I am much happier and more efficient if I get up when I need to, otherwise I procrastinate. When I get slightly restless, I set the timer for 5-10 minutes, then take a snack, garden, or creativity break until time's up. When very restless, I shut everything down, and go for a flashcard walk up the hill or down to the ocean. You are in control of your study-journey.

When you’re bored, exhausted, or procrastinating, go take a break. Stay efficient. Don’t get bogged down in details. Clarify what you don’t understand, then move on. 


Rest


Schedule in time for rest and play. Spend time outdoors. Get exercise. Spend time with friends.

These things are simple to say, but must be scheduled in during test preparation. Otherwise, focused zeal can take over, frazzling the nervous system.

Have fun with your studies. How can this process be joyful? This is a precious moment. You are here now, and will not be here again, as a soon-graduating or freshly-graduated acupuncturist, preparing for licensure. This is purgatory. Welcome here now. Look around. Enjoy it, while you’re here. Have fun.


Test Preparation Tips


I focused on my weak spots during TCM-tests free days, the first Tuesday of each month. I took all most of their mock exams for each NCCAOM category prior to those exams, also during free days. I scheduled weekly mock exams the final month leading to the CALE (part of the TCM-review program). Utilize both free and paid resources!

I memorized the entire “Big Picture” page from HB Kim, and all 83 formulas and categories. I scribbled both down within 20 minutes every week. If I started dropping information or going slower, then I would increase the frequency to twice a week, every other day, or daily. 

Prior to my actual exam, I scribbled down most of the Big Picture, then added other acupuncture or herbal lists as necessary. They only allowed me one piece of scratch paper, so I kept my reference tables concise. I repeatedly wrote and erased notes throughout the test in the remaining space.

I developed these test-taking strategies during my 4 mock exams. I tested in a quiet focused environment, similar to the actual testing environment. I gave myself a 10-minute bathroom/ snack break every 50 questions, which I aimed to finish in an hour. I’d studied enough that I trusted my intuition more than my logical mind: if my first thought is A, then go with it. Don’t doubt, and certainly don’t overthink. Keep it simple. Keep moving.


Western medicine


I felt prepared to take my exam with my review course, except for western medicine. Western medicine is a vast topic. The professor who covered that section of the TCM-review course frequently went off-topic, veering into personal/ clinical stories that are interesting, but unnecessary for test preparation. I sped through those videos at 2.5x speed. 

I spent three days sitting by the ocean, reading through the entire biomedicine section of HB Kim. I made tables for what I found confusing or intriguing, and drilled flashcards and quizzes. 


Scheduling exams


Most California students take both the NCCAOM and CALE, for a total of five exams. After doing much research, I too chose this route, although it is more expensive, stressful, and time-consuming. It is better to take these exams while the information is still fresh from school. Once clinical practice begins, the didactic academic information falls away, while sitting-still-and-studying ability also declines.

Either complete or start taking the NCCAOM while still in school. Most of my peers from my past schools (in FL and OR) completed the NCCAOM while finishing their final year of school. I incorrectly thought that that rule was different in California, but it is not: pass it while it’s hot. Get it done.

My testing schedule

Bina was instrumental in my study strategy. I came to deeply trust her judgment. She suggested taking the NCCAOM foundations and acupuncture modules first, CALE, and then biomedicine and herbs. Because of time constraints, my testing schedule ended up as:
1. NCCAOM foundations module
2. CALE
3. NCCAOM acupuncture module
4. NCCAOM biomedicine module
5. NCCAOM herbs module

After graduation, I focused my energy and passed the NCCAOM foundations module. You can read about that journey here. Preparing for the foundations module solidified that information in me. I felt confident and indestructable here, only revisiting these flashcards intermittently until my big CALE exam, rifling through one final time right before CALE.  

I took the NCCAOM acupuncture module one week after the CALE. It has slightly different content than the CALE, which required an about-face in these categories:
- needle depth
- point location
- crossing points
I read through HB Kim for these sections, and scoured Quizlet for others’ resources. I only drilled these categories, trusting that my CALE-prep was sufficient to also carry me through the NCCAOM for other categories, especially within such a short span of time between these two exams.

Success.

The test


Visit my "Ode to Tests" post for some before, during, and after test strategies and suggestions. 


The end


“Geoff,” I texted my mentor, two weeks before my scheduled CALE exam, “Can we talk?” We spoke on the phone a few hours later. I had completed my 6-month TCM-review course. My CALE exam was scheduled in 2 weeks. I still didn’t feel ready. I was confident in some areas, but weak in other areas. I knew my weak spots, and feared them. Am I good enough? Am I ready enough? Take it now, or push the test back? Geoff counseled me, “Give it all you’ve got. You’ve studied. You’re prepared. You’re at peak performance state. Get it.” He said, “Go in with the intention to kill the beast. Even if you don’t kill it, you hurt it bad. It walks away limping.” This fiery bold image, coupled with my usual more-peaceful ancestral-prayers, and months of dedication and struggle, carried me through to test day.

“祖先們! (Zu xian men),” I call out to the sunrise ocean, “Ancestors!” I’ve already walked through a few hundred flashcards in the dawn chill, barefoot through the cold sand. I feel tired and overwhelmed, and am asking for support from my ancestors, the same questions I would later ask Geoff: Am I ready? Is it time?

Six dolphins simultaneously swim by, blow-holing parallel sprays of water high above waves, alighting my heart with hope and possibility. Here we are.


The beginning (What now?)


I’m building my practice. It’s difficult to rest after months of intense dedication. The fire that lit my test-preparation path now guides my business-building trail. This is a life-long journey of adventurous study, with its challenges and triumphs. I am grateful. 

Have fun!

8.10.2019

Board exam 1


The test was difficult. It was mostly what I'd prepared for, except different diagnostics thrown all together for answer possibilities, and more "treatment plan" type questions than straight "diagnosis" questions.

I cancelled all work and social engagements the week before the test, cycling through old quiz questions on TCMreview.com and reviewing flashcards, honing in on weak spots. Two days before the exam, I took two full-length mock exams on TCMtests.com. The day before the exam, I took a self-constructed mock-exam at the same time as I'd perform the next day, relaxed (surf, hike, do a few more flashcards to ease my mind), ate a delicious nutritious macrobiotic supper, took a walk, took a bath, slept, then woke at 5:30 AM to perform--- and succeed.

I take a break at the half-way mark (50 questions down, 1 hour in) to pee, take some power-poses in the bathroom mirror, and devour a chocolate bar. The two hours fly by. Every time I start sweating or feeling anxious, I stop, take "chin" mudra (connecting my thumb and forefinger), breathe deeply, then proceed. The computer doesn't allow me to cross out answers or highlight important points, so I fill my scratch- paper with small bullets, key points, and doodles. I draw symptoms for complex cases onto a doughy-sticky-figure human body. I draw out complex tongue and pulse diagnoses. I knock off wrong answers on my bullet-points.

My feelings at the end of the test, as I put a hand on my heart, still my breath, then click "next" to complete the exam--- are complex. The screen flashes "pass" and I hold back tears in the quietly clicking testing room. I am beyond words, and still am.

This is the first of five tests, and an auspicious beginning. I am grateful to everyone who made this focus possible, and my studying-process joyful, meaningful:

Ben, for your playfulness, delicious meals, and adventure partnership. My yoga community, who keeps me responsible, sane, and life filled with purposeful sacred embodied play. Cynthia, for reminding me that this testing process is an opportunity for presence, and to enjoy it while I'm here, while honoring Body Wisdom. The Ocean, for cleansing my body, heart, mind, and sinuses. The mountains for grounding and magic. David, Geoff, and Justin for sharing  parallel TCM experiences, and continual inspiration and inquiry. Geoff, for reminding me to "keep swimming." My grandpa from six generations ago, who wrote our family poem that inspires this journey, informs my name and spirit, and infuses my life with love, meaning, excellence, and dedication to lineage. To all my family and friends, and seen and unseen forces. To all my relations. 

Taking the test itself feels like a very solo adventure, like traveling to a new country where I've never been, and know no one, with a mission to "get the treasure--- and bring it home." I've prepared intensely for the mission, but upon landing, it's still a whole new planet. I'm grateful for my large community of support at home. It's nice to be able to leave--- and come back. Next time, the testing process will hopefully be easier, more familiar. Continued dedication (with strategic restful play) until then.

Next tests: September, October, February, May. Thanks for joining my journey.

Big Love.
Deep bow.

(from a journal entry after the NCCAOM Foundations exam, written in the Sespe Wilderness. I went for a short 24-hour backpacking journey the day that I completed the exam.) 

2.23.2019

Ode to Tests


I wrote this post almost immediately after my graduation exam. I didn’t know test results yet, but was so adrenaline high from the test, and exhausted after months of preparation, that I had to write something about the process. If you are preparing for a big exam, then I hope that this is helpful for you. (And yes, big relief, I passed.)

Ode to Tests

Clinic entrance exam. Clinic exit exam. Graduation exam. And now, coming up, the California board exam. Then, four national exams (NCCAOM). One exam after another, the never-ending march of terror and exhaustion. I greet you with flashcards and chocolate. For you, dear reader, perchance a fellow student, perchance a curious onlooker, I share these test-tackling strategies that have carried me through, and will hopefully continue to carry me through, to graduation, and subsequent licensure. One small win at a time.

Before the Test

Prepare
Flashcards. Review daily. Go onto www.quizlet.com and make an account. Plug in small digestible snippets of all collected and pertinent information. Organize into categories. Study by category. Do flashcards everywhere. I studied flashcards while hiking backcountry, flying across the country, soaking in steaming baths. I flipped through 100 flashcards pre-dawn before leaving the bed, 100 more before falling asleep, and in every possible open moment: standing in grocery lines, waiting for gas, and even while stuck in hellish Los Angeles traffic. Practice tests. Practice tables. Get familiar with the material from every direction. Talk about it with everyone. Look up what you don’t know. Make it fun, visual, creative. Color-code. Bring it to life. Spaced repetition, dedication. Set a study plan, and follow through.

The Day Before
No cramming. Your last day of studying is 2 days before test day. After weeks to months of accumulated effort, allow yourself to rest the day before the test. Eat well: healthy whole foods that will energize you all through the next day. Go for a hike. Do what gives you joy. Flip through a few more notes to ease your mind, but remain calm. Before bed, have everything prepared for your test day: clothing, food... everything. Visualize your plans for the whole test. Picture success. Feel it. Sleep early.

Day Of
Stretch in the morning. Eat well. Maintain a relaxed focus. Enter the zone. Get there early. Game on.

During the Test

Food and Drink (this worked at school, but board exams will only allow water)
If the test allows it, then bring ample fuel: relaxing tea for nervousness (Kava, Rose, Passionflower), stimulating tea for the easily bored (Green tea). I had tea bags of both. Coffee or wine for the decadent (I like chocolate covered coffee beans). Chocolate for joy, comfort, and energy. Oranges for an energizing wake-up call. Roasted sweet potatoes for satisfying long-lasting energy. A protein bar to quickly satiate true hunger. Cookies for true decadence. A dropperful of a relaxing or stimulating tincture (relaxing for me) beforehand, to get things started on the right foot. An extra secret squirt into the tea, for extra good luck.

The Test
Start with what you know: I scribble out a few reference tables before starting the test itself. They smile at me with my test and food, helpful for when I get overwhelmed, reminding me of the basics. Flip to the section of the test that is easiest, and finish it. Build confidence. Return to a hard section. Alternate back and forth: build confidence, tackle something challenging. Note the time. Move quickly. Let go, if something is too difficult. Mark the page to return later. Trust intuition: first thought is often correct. Bubble it into the answer sheet. Mark what I’m unsure about, to double check after completing the entire test. Only double check those answers. Onwards.

Movement
Get up to to “pee” at least once an hour. Give your brain a break. Pace around in the bathroom or hallway for a little bit. Get some blood flowing into the body and brain. Take a breather. Swing your arms around. Then return to the testing room.

Maintain focus, but rest as needed. Close your eyes. Take slow deep belly-to-chest breaths in and out of the nose. Remind yourself, “It’s okay,” with palms facing up under the table, or pointer finger and thumb meeting in “anjali mudra.” More relaxation for more success. Then, back to it.

After the Test

First, rest. It’s been a journey. Celebrate both wins and losses. Review the test. Learn from mistakes. If there’s more tests on the horizon, then make more flashcards from fresh test material. Re-strategize as necessary. Onwards. 

~

Other Resources
Here's a podcast on high-level performance under stress, from Scott Weingart.
(image from Scott Weingart)